PILES ( from Lit. pile, ball), or FIENton anoms. Small tumors situated either within or on the verge of the anus. They consist of dilated veins containing either fluid blood or a solid clot, covered with inflamed. infiltrated or permanently thickened mucous membrane. They are termed internal when situated above or within the sphincter: extcrnal when below or outside it. Piles vary greatly in size and struc ture, and in the symptoms they produce. They may be merely little knots of varicose veins in the submucous tissue; these may in time in crease in size, be forced in and out during defecation, become inflamed and strangulated, and even ulcerated and gangrenous. External hemorrhoids usually do not bleed: the internal variety, which extend above the sphincter for an inch or more. are soft, purple irregular masses. and bleed readily when irritated by hardened flecal masses. Jrtcrial piles contain, besides a large vein, arteries of some size. These bleed easily and freely. but are comparatively rare. Children are occasionally afflicted with capillary piles, small. sessile tumors. which also bleed.
lIemorrhoids are caused by any circumstance which produces long-continued venous congestion in the rectum. Constipation, enlargement of the prostate gland, pregnancy, tumors of the uterus or its appendages, congestion or cirrhosis of the liver, certain diseases of the heart and lungs. sedentary occupations. and relaxing climate, are a few of the causes. Over use of harsh cathartic's and horseback riding are also mentioned as fac tors.
The following are the general symptoms of this The patient, after having experi enced for a varying time a feeling of heat. full ness, and dull pain about the lower part of the bowel, becomes conscious of a foreign body in the anus: and, on examination, discovers a small tumor, which either remains outside or is re tracted. according as it originated without or within the sphincter. This tumor gradually increases. and others form around it, until a mass at length results as large as a pigeon's egg.
or larger. In its ordinary indolent state the tumor has little sensibility. and °pensions com paratively little annoyance: but when inflamed it is exquisitely tender to the touch. and is the seat of hurtling and stinging sensations. render ing the evacuation of the bowels (and sometimex of the bladder also) difficult and painful. In women an inflamed pile may cause pain in the back, and other anomalous symptoms. in severe eases the patient can neither stand nor sit with comfort, and only finds relief in the horizontal position.
Piles may be prevented by active exercise. mild saline catharsis. a light laxative. non-stimulating diet. These measures may also avail to cure or hold in abeyance the affection in its earlier stages: and, with the exception of the first. are always indicated in conjunction With other means of treatment. Scrupulous cleanliness must al ways be observed. When inflamed, in addition to the above precautions, piles 5110111(1 be treated by absolute rest, warm flunentations. and the injection of cold water into the rectum several times a day. As the acute symptoms subside, astringent and sedative lotions, such as lead water and laudanum. and extract of hamainclis, may be applied. Internal piles that protrude must be pushed back; if they bc.come stran gulated, hot applications are to he used until reduction is possible. For the bleeding. which is sometimes severe. cold applications and injections usually suffice. Hemorrhoids occasionally be come so troulde,“mic as to make life a burden, and operation is the only measure that will bring relief. The tumors. if external, may he simply tied with ligatures at the base and cut off. In ternal piles may be drawn down with forceps and treated in the same manner. In persistent eases the whole pile-bearing area of 1111.1e011 mem brane may be dissected off and removed, and healthy membrane brought down to take its place.